Chronic Pain and the Brain

As bodyworkers we all treat people in pain and most of the time successfully. But what if your client has had pain for more than 3-6 months and is not responding to your or any other treatments?

It’s possible that it’s neuroplastic pain (also known as neural circuit pain, central sensitization, TMS (tension myoneural syndrome)

Neuroplastic pain results from the brain misinterpreting safe messages from the body as if they were dangerous. In other words, neuroplastic pain is a false alarm. Though the pain can be addressed through various practices, this does not imply that the pain is imaginary. The pain is REAL!

“The relationship between pain and the state of the tissues becomes weaker as pain persists”  Dr. Lorimer Moseley

In other words the longer the pain persists the higher the chance it’s being caused by the brain and nervous system. Without the brain there is no pain.

Neuroplastic pain is caused by a brain/nervous system which has gotten stuck in sympathetic arousal – fight, flight, freeze and does not swing into a parasympathetic state for very long. Most treatments that focus on the area of pain don’t work, providing temporary relief at best because there is nothing wrong in the body.

Hard to wrap your mind around, right?!

What if you suspect that a client’s pain is brain/nervous system based?

• Do your research before talking with your client (scroll down for a list of resources)
• I often begin the conversation with a fact people can relate to: Muscles, tendons, ligaments and fascia are puppets of the nervous system and the brain is pulling the strings (Brian Clark, Ph.D. Professor of neuroanatomy Ohio State University).
• The most common response is: “You mean this is all in my head!” Reassure them that their pain is VERY real. Be extremely compassionate. Often people have been searching for answers for years and are frightened, despairing and hopeless. They may have 10 different diagnoses (a red flag!) and have tried everything. They may have been told they would just have to live with it for the rest of their lives. (FYI- this is often told to people with fibromyalgia which is definitely brain based pain) They don’t – there IS a way out.
• The most important thing you can do is create safety. Chronic pain elicits fear and terror and a sense of visceral safety is not available to them most of the time.
• Concentrate on modalities that elicit a parasympathetic response. Don’t treat the pain directly. Remember, there is nothing wrong in the body. Their nervous system will solve the problem in time – we just don’t know how long it will take.

This is a complex subject – I hope this primer on chronic pain has been helpful

RESOURCES:

WEBSITES:

Unlearnyourpain.com  - Dr. Howard Schubiner- a giant in this field

tamethebeast.org: Lorimer Moseley, Ph.D

Thepainpt.com: Jim Prussack an amazing physical therapist

FYI: More and more physical therapists are getting trained in treating neuroplastic pain. The insurance diagnosis is central sensitization, and it is covered.

BOOKS

Alan Gordon, LCSW: The Way Out (this is the book I recommend to my clients)

Dr John Sarno: The Mind Body Prescription

Steve Ozanich: The Great Pain Deception

RESEARCH

There’s more and more research available now – we are redefining pain.

Here’s a research paper:

https://medical.advancedresearchpublications.com/index.php/CHCMJ/article/view/1283